Fraxel employs a technology called non ablative fractional resurfacing. It is non ablative becausethe epidermis, the top layer of the skin, remains intact after Fraxel treatment. Fraxel ablative lasersurgery is in between the initial resurfacing that was done with CO2 ablative resurfacing, which washighly successful to treat aging skin, acne scarring, and rejuvenate the skin but did create prolongedredness and had an increased risk of discoloration and scarring in the skin. On the opposite end of laserrejuvenation is non ablative, non fractional laser rejuvenation. It is effective for treating aging skin andacne scarring with minimal to no redness or down time.
Fractional ablative, otherwise known as Fraxel laser, is technologically somewhere in between. It worksby firing high energy pulses deep into the skin but leaving the top layer of the skin intact. This makes theprocedure safe. The deep firing of laser light through the skin does cause redness that lasts on averagetwo to four days as opposed to weeks with CO2 ablative laser.
Fractional ablative resurfacing is most effective for treating background sun damage. Background sundamage is the brown mottling and roughening that occurs of the skin with chronic sun exposure. Fordiscrete large freckles that occur with aging of the skin, Q-switch lasers, which are performed in ouroffice as well, are most effective and often we combine fractional resurfacing with Q-switch lasers forthe maximum improvement for our patients.
In addition to treating sun damage, fractional lasers are highly effective to treat acne scarring andsurgical scars. A series of treatments results in an improvement in scars. Currently fractional resurfacingtechnology is thought to be the safest and most effective treatment for improving scars.
When the fraxel was first released it was thought to be a miraculous treatment for melasma. Melasmais related to a combination of sun damage and hormones that causes pigmentation on the cheeks, upperlip, forehead, and chin in any combination, usually more prominent in the summer months after sunexposure. Initial reports with fraxel were encouraging that it did seem to have long term improvement.However, with subsequent, it has become clear now that melasma does recur and fraxel currentlyremains a tertiary, not primary treatment, for melasma. We do have good treatments including topicalcreams and chemical peels to improve it but there is no cure for it.
How is fraxel done?
Fraxel is performed as an outpatient using a topical anesthetic cream. The treatment takesapproximately twenty to forty minutes. After the procedure a moisturizing cream is applied. There isusually no associated pain after the procedure. Wound care entails keeping the skin well moisturizedfor two to three days. Patients are able to wear make-up after the procedure. Most patients resumenormal activities immediately. There is background redness that looks like sunburn. After three tofour days the redness fades to the point that patients are able to resume full regular social and physicalactivities.
How many treatments?
Typically, the patient undergoes two to four treatments.
How safe is it?
Fraxel is a safe laser treatment but as with any treatment there is a possibility for side effects. Sideeffects can be minimized but not eliminated by having Fraxel done by an experienced laser surgeon withappropriate energy settings.